Active NPI
Marycarol Park, LCPC
- Professional Counselor
- North Aurora, IL
National Provider Identifier
1700646262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.015794
- Practice address
- 2465 Moutray LN
North Aurora, IL 60542-2111 - Phone
- (720) 331-8315
- NPI assigned
- Mar 21, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.015794 | IL | Primary |
Addresses
Primary practice location
2465 Moutray LN
North Aurora, IL 60542-2111
Mailing address
2465 Moutray LN
North Aurora, IL 60542-2111
Phone (720) 331-8315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.015794 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711324800000",
"number": "1700646262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2465 MOUTRAY LN",
"city": "NORTH AURORA",
"state": "IL",
"postal_code": "605422111",
"telephone_number": "720-331-8315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2465 MOUTRAY LN",
"city": "NORTH AURORA",
"state": "IL",
"postal_code": "605422111",
"telephone_number": "720-331-8315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARK",
"first_name": "MARYCAROL",
"name_prefix": "Mrs.",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-21",
"last_updated": "2024-03-25",
"certification_date": "2024-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.015794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Aurora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.